Individual provider Active NPI

Chancelor Cruz, MD

  • Neurology Physician
  • Los Angeles, CA
National Provider Identifier
1407341860
Registry record updated Apr 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
A163485 Issued in CA
Practice address
1200 N State Street
Clinic Tower, Suite A7D
Los Angeles, CA 90033-1029
Phone
(323) 409-1000
NPI assigned
Jun 28, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X A163485 CA Primary

Addresses

Primary practice location

1200 N State Street
Clinic Tower, Suite A7D
Los Angeles, CA 90033-1029

Mailing address

5000 Sunset Ave
Los Angeles, CA 90027

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address chancelor.cruz@ventura.cernerdirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220419002850 CA Practitioner - Psychiatry 8426445529 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1224 Vine St
Los Angeles, CA 90038-1612
Phone (323) 769-6100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A163485CAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Los Angeles County Department of Mental Health CurrentSince Aug 8, 2022 Accepting new patients
Los Angeles County Department of Mental Health Current Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Aug 8, 2022 Accepting new patients

Locations

17707 Studebaker Rd
#150
Cerritos, CA 90703
Phone (310) 402-0688

10515 Balboa Blvd
Granada Hills, CA 91344
Phone (818) 486-3837

349A E Avenue K6
Lancaster, CA 93535
Phone (661) 723-4260

1816 S Figueroa St
Fl 6
Los Angeles, CA 90015
Phone (213) 763-0300

510 S Vermont Ave
Fl 19
Los Angeles, CA 90020
Phone (213) 480-3416

5321 Via Marisol
Los Angeles, CA 90042
Phone (323) 474-6393

1224 Vine St
Los Angeles, CA 90038
Phone (323) 769-6100

2323 E Palmdale Blvd
Palmdale, CA 93550
Phone (661) 223-3800

3741 Stocker St
Ste 200
View Park, CA 90008
Phone (323) 290-5800

Interoperability endpoints

  • Direct secure messaging: chancelor.cruz@ventura.cernerdirect.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714435200000",
    "number": "1407341860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 SUNSET AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N STATE STREET",
            "address_2": "CLINIC TOWER, SUITE A7D",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900331029",
            "telephone_number": "323-409-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUZ",
        "first_name": "CHANCELOR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-28",
        "last_updated": "2024-04-30",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A163485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "chancelor.cruz@ventura.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Cerner Direct Secure Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Information",
            "address_1": "300 Hillmont Ave",
            "city": "Ventura",
            "state": "CA",
            "country_code": "US",
            "postal_code": "930031651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.